Living arrangements, health and well-being: A European Perspective

1. Living arrangements, health and well-being: A European Perspective UPTAP Meeting 21st March 2007 Harriet Young and Emily Grundy London School of Hygiene and Tropical Medicine

2. Background • Demographic changes over the last century have led to older age structures throughout Europe. • Declines in the proportions of older people living with children and increases in proportions living alone.

3. Background What are the implications for health and well-being ? Research to date: • Those living with spouse are the most healthy • Contradictory evidence for those not living with spouse: more healthy living with other relatives or living alone ? • Michael et al (2001), Grundy (2001) • Selection effects • Effects vary according to cultural and socio-economic context

4. Research Objectives • 1 & 2: Analyse associations between living arrangements, health and well-being among older people • Across Europe, examining differences between groups of countries • In more detail for England / England and Wales • 3: Examine pathways to living arrangements and the effect that allowing for these has on health in England and Wales

5. Variables • Different outcome variables • Scales of happiness scale, satisfaction with life & loneliness • Psychological morbidity – CES-D depression scale • Self-rated health & limiting long term illness • Indicators of functional capacity • Mortality • Explanatory variable • Living arrangements: • spouse only, • spouse and other, • Children or others only, • Alone

6. Dataset: European Social Survey (ESS) • Two cross-sectional rounds of data – 2002 and 2004 • Using data from 19 countries • Sample size 18,131 people aged 60+

7. Country groupings

8. Dataset: English Longitudinal Study of Ageing (ELSA) • Two waves of data in 2002 and 2004 • Cross-sectional dataset of population aged 60+ in Wave One – 7146 people • Longitudinal dataset of population aged 60+ in Wave One and present at Wave Two – 5443 people

9. Dataset: Office for National Statistics Longitudinal Study (LS) • A record linkage study of population of England and Wales, with 4 census points linked in, plus census information on household members at each census. • Dataset of population aged 60+ at 2001 Census and present at all 4 census points: 80,937 people. • Dataset of population aged 60+ at 1991 Census and present 1971-1991: 91,155 people

10. Psychological health and well-being • Associations between living arrangements and…. • ESS: Happiness and satisfaction with life scales (0-10): ordinal regression • ELSA: 8 point CES-Depression score (0-2 compared with 3+): logistic regression • ELSA: Loneliness scale (9 item scale from 4 questions): linear regression

11. ELSA This model controlled for gender, age, smoking, wealth, housing tenure, contact with relatives, contact with friends, membership of social organisations and self-rated health status

12. ELSA This model controlled for gender, age, contact with relatives, contact with friends, membership of social organisations, health status at wave one, presence of depression at wave 1

13. ESS Adjusted odds ratios from ordinal regression of living arrangements on happiness compared with those living with a spouse only, 19 European Countries, ESS 20002-4(lower OR =less happy) ** P<0.01 *** P<0.001 Models also adjusted for region, age, income, education, feelings about income, social meetings and activities, current widowhood and presence of limiting long term illness.

14. ESS Table 3: Odds ratios from ordinal logistic regression of living arrangements & other factors on happiness for non-marriedwomen, 19 European countries ESS 2002-4* * Model also controls for age, region, income, education, feelings about income, indicators of social contacts, whether currently widowed, & region for Europe-wide model ** p<0.01 *** p<0.001

15. Self rated health and mortality Associations between living arrangements and: • Self rated health using • ELSA (binary variable: poor & fair vv excellent & v good & good health): logistic regression • ONS LS (binary variable: good & fair health vv poor health): logistic regression • ESS (6 level variable): ordinal logistic regression • ONS LS: death 2001 Census to end 2004: logistic regression

16. ELSA This model controlled for gender, age, smoking, wealth, housing tenure, contact with relatives, contact with friends, membership of social organisations and self-rated health status

17. ONS LS Odds Ratios from logistic regression of poor self-rated health on living arrangement change 1991 and 2001 for people aged 60+. England and Wales, ONS LS. Model also controlled for age, gender, tenure and car access score, region and limiting long term illness in 1991. Source: ONS Longitudinal Study, Authors analysis.

18. ONS LS Odds Ratios from logistic regression of poor self-rated health & death on living arrangement change 1991 and 2001 for people aged 60+. England and Wales, ONS LS. Model also controlled for age, gender, tenure and car access score, region and limiting long term illness in 1991. Source: ONS Longitudinal Study, Authors analysis.

19. ESS Self rated health and living arrangements: ESS data • No significant associations between self-rated health and living arrangements for all regions combined. • However, living alone was associated with poorer health than those living with a spouse for women in Northern countries and men in Western countries.

20. Limitations • Comparability of variables between datasets • Proportion of population in institutions differs throughout Europe – exclusion of this group may have biased ESS results. • Longitudinal analysis: 10 yearly interval for change in living arrangements using ONS LS.

21. Conclusions • Clear association between living alone and higher levels of depression, loneliness and unhappiness (ESS & ELSA). • Contradictory findings on self-rated health. • Differing findings depending on health indicator used

22. The End Thank you Harriet.Young@lshtm.ac.uk Emily.Grundy@lshtm.ac.uk